Note: The degree of the offense
depends on the classification of the underlying crime. See § 53a-172 (first
degree: felony); § 53a-173 (second degree: misdemeanor or motor vehicle
violation which a sentence of a term of imprisonment may be imposed).

The defendant is charged [in count
___] with failure to appear in the (first/second) degree. The statute defining
this offense reads in pertinent part as follows:

a person is guilty of failure to
appear in the (first / second) degree when while on probation for conviction of
a (felony / misdemeanor / motor vehicle violation), (he/she) wilfully fails to
appear when legally called for any court hearing relating to a violation of probation hearing.

For you to find the defendant guilty
of this charge, the state must prove the following elements beyond a reasonable
doubt:

Element 1 - On probationThe first element is that the
defendant was on probation for a conviction of a (felony / misdemeanor / motor
vehicle violation). I instruct you, as a matter of law, that the crime of <insert
underlying charge> is a (felony / misdemeanor / motor vehicle violation).

Element 2 - Duty to appearThe second element is that on <insert
date>, the defendant was required to appear before (a court or judicial
officer) in connection with the charge of violation of probation.

Element 3 - Failure to appearThe third element is that the
defendant wilfully failed to appear as required. An act is done wilfully if
done knowingly, intentionally, and deliberately. In order to prove this
element, the state must prove beyond a reasonable doubt either that the
defendant received and knowingly, intentionally, and deliberately ignored a
notice to appear or that the defendant knowingly, intentionally, and
deliberately embarked on a course of conduct designed to prevent (him/her) from
receiving such notice.1<See
Knowledge, Instruction 2.3-3.>

Conclusion

In summary, the state must prove
beyond a reasonable doubt that 1) the defendant was on probation for a
conviction of a (felony / misdemeanor / motor vehicle violation), 2) (he/she)
was required to appear on <insert date> in connection with the charge of
violation of probation, and 3) (he/she) wilfully failed to appear.

If you unanimously find that the state
has proved beyond a reasonable doubt each of the elements of the crime of
failure to appear, then you shall find the defendant guilty. On the other hand,
if you unanimously find that the state has failed to prove beyond a reasonable
doubt any of the elements, you shall then find the defendant not guilty.
_______________________________________________________